Why Kenyans are collapsing in banking halls, streets

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Nurse taking a blood sample from a patient.

Kenyans were baffled after reports of people collapsing in banking halls, after alighting from matatus or when walking in the streets.

Upon admission to hospital, medics singled out blood clotting as the reason. There has thus been a growing awareness about the risk of blood clotting disorders, including blood clot within the lungs or pulmonary embolism.

Dr Laura Chebet Kirui, a Consultant Haematologist at the Aga Khan University Hospital explains to Yvonne Kawira why a new Haemostasis and Thrombosis clinic was established to deal with clotting and other blood disorders.

Tell us more about the new Haemeostasis and Thrombosis clinic.

Our aim with the new clinic is to provide a comprehensive service for patients who present us with these problems and deal with them from testing to diagnosis and treatment, especially because some of these problems require lifelong treatment.

What are some of the most common blood disorders?

Some of the most common clotting problems are venous thromboembolism (VTE), which include deep vein thrombosis (DVT) – clotting within the deep veins of the body, pulmonary embolism – clotting in the veins within the lungs, and via our neurology colleagues we also receive referrals for patients who have blood clots in the venous circulation of the brain.

  • In the last year alone we received between 250 and 300 patients with VTE. Many of these will have been caused by particular risk factors such as recent surgery, long haul travel or even pregnancy. However, there are people who experience unexplained venous blood clots and these people, in particular, need further investigation to prevent this from recurring.

The clinic also investigates bleeding disorders and provides support for patients with some of the rarer bleeding disorders such as haemophilia and von Willebrand’s disease, which are inherited conditions that result in a lack of specific clotting factors within the blood.

There is a delicate balance of these factors within blood that prevents too much clotting or too much bleeding.

How are bleeding disorders diagnosed?

When a patient comes to the clinic the history of their symptoms; severity, duration, type of bleeding and whether any other family members are affected determines how we proceed. Some of these bleeding disorders can be detected early. In severe cases of Hemophilia, it can be detected in childhood and may need lifelong treatment.

In these cases, children can have problems with bleeding into the joints when they learn to walk, or when they have dental procedures or during circumcision.

How are these disorders treated?

Treating these conditions very much depends on the severity of the disorder as well as the type of the disorder. Treatment for bleeding disorders is directed at preventing harm to the patient by minimizing the risk of bleeding, some patients may only need treatment before surgery or dental work for example. It is important to note that one cannot acquire these disorders from blood transfusion.

How does the clinic help in cases related to pregnancy?

The clinic also provides a supportive service to some of the other medical specialities. Obstetrics is one example.

Pregnancy itself can be a risk factor for clotting disorders. We see patients in the clinic with a variety of complications associated with pregnancy. Patients with a history of recurrent miscarriage can have a small percentage having underlying clotting abnormality and management may be helpful.

We also see patients who develop venous clots in pregnancy and we support the Obstetric team to ensure safe delivery and management post-delivery, these women will also need management in subsequent pregnancies.

It is not only blood clots which can occur in pregnancy some patients can be at risk of bleeding disorders as well.

Patients can also develop abnormalities in the blood during pregnancy such as low platelets which puts them at risk for bleeding. Women who have inherited a bleeding disorder also require specialist care at this time.

What other areas does the clinic look to help in?

Haematology is a broad field. Some aspects of haematology are more well-known such as blood-related cancers like leukaemia and lymphoma, blood transfusion and the anaemias like sickle cell disease. We have excellent well-established services in these areas; now we can offer a dedicated specialist service to an underserved population of patients with clotting disorders which are often not well understood. This will ensure accurate diagnosis, improve patient education on their condition and provide patient-centred management.

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